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        <h1>
            Alcoholism</h1>
        <h5 class="updated">
            Last updated: Wednesday, 27, October, 2010</h5>
        <table cellpadding="0" cellspacing="0" class="two-column-process">
            <thead>
                <tr>
                    <th>
                        Presentation</th>
                    <th class="description">
                        Appropriate Tests</th>
                </tr>
            </thead>
            <tr class="odd">
                <td class="first">
                </td>
                <td class="second">
                    <p>
                        Diagnosis is based on clinical assessment.</p>
                    <p>
                        Laboratory tests include: <b>FBC, blood film; PT; GGT, urate, triglycerides</b>, 
                        as appropriate; <b>ethanol is</b> helpful in detecting recent alcohol ingestion.</p>
                    <p>
                        In chronic alcoholism, macrocytosis, thrombocytopenia, prolonged PT, elevated 
                        GGT, hyperuricaemia or hypertriglyceridaemia may be found. The most specific 
                        indicator of chronic excessive alcohol ingestion is carbohydrate-deficient 
                        transferrin but it has a low sensitivity.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <b>Alcoholic liver disease</b></p>
                </td>
                <td class="second">
                    <p>
                        <b>AST, ALT, ALP, bilirubin, albumin, protein (total), PT.</b> An AST/ALT ratio 
                        of &gt;1 suggests liver disease is due to alcohol. <b>Protein electrophoresis</b> 
                        or <b>immunoglobulin quantitation</b> may assist in establishing chronicity. <b>
                        Liver biopsy</b>, if indicated.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Fatty liver</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Alcoholic Hepatitis</p>
                </td>
                <td class="second">
                    See
                    <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=305&amp;Itemid=27" 
                        target="_blank">Hepatitis</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=137&amp;Itemid=27" 
                            target="_blank">Cirrhosis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=304&amp;Itemid=27" 
                            target="_blank">Hepatic failure</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Hepatocellular carcinoma</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=346&amp;Itemid=27" 
                            target="_blank">Portal hypertension</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=500&amp;Itemid=27" 
                            target="_blank">Pancreatitis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <b>Acute metabolic disorders</b></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=354&amp;Itemid=27" 
                            target="_blank">Hypoglycaemia</a></p>
                </td>
                <td class="second">
                    <p>
                        <b>Glucose.</b></p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=384&amp;Itemid=27" 
                            target="_blank">Ketoacidosis</a></p>
                </td>
                <td class="second">
                    <p>
                        <b>Electrolytes, hydroxybutyrate.</b></p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=386&amp;Itemid=27" 
                            target="_blank">Lactic acidosis</a></p>
                </td>
                <td class="second">
                    <p>
                        <b>Electrolytes, lactate.</b></p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=350&amp;Itemid=27" 
                            target="_blank">Hypoalbuminaemia</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=341&amp;Itemid=27" 
                            target="_blank">Hyperlipidaemia</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <b>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=428&amp;Itemid=27" 
                            target="_blank">Malnutrition</a></b></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Wernicke-Korsakoff syndrome</p>
                </td>
                <td class="second">
                    <p>
                        If confirmation is required, blood must be collected for <b>vitamin B1</b> assay 
                        prior to therapy.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Central pontine myelinolysis&nbsp;</p>
                </td>
                <td class="second">
                    <p>
                        A demyelinating syndrome associated with rapid sodium fluxes. Electrolytes.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Peripheral Neuropathy</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <b>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=106&amp;Itemid=27" 
                            target="_blank">Cardiomyopathy</a></b></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <b>Infection</b></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=761&amp;Itemid=27" 
                            target="_blank">Pneumonia</a></p>
                </td>
                <td class="second">
                    <p>
                        Aspiration of upper respiratory tract bacteria esp <em>Streptococcus pneumoniae</em> 
                        and <em>Klebsiella pneumoniae</em>. Alcoholism also predisposes to infection 
                        with <em>Legionella pneumophila</em>.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Bacteraemia/<a 
                            href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=693&amp;Itemid=27" 
                            target="_blank">Septicaemia</a></p>
                </td>
                <td class="second">
                    <p>
                        Inability of the liver to deal with bacteria coming from the gastrointestinal 
                        tract in the portal system predisposes to septicaemia caused by Gram-negative 
                        bacilli, eg <em>Escherichia coli</em>, <em>Klebsiella pneumoniae</em>.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=617&amp;Itemid=27" 
                            target="_blank">Peritonitis</a></p>
                </td>
                <td class="second">
                    <p>
                        Primary infection with <em>Streptococcus pneumoniae</em> or Gram-negative 
                        bacilli, eg <em>Escherichia coli</em>. Diagnosis established by aspiration of 
                        peritoneal fluid for microscopy and culture (peritoneal fluid examination).</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=764&amp;Itemid=27" 
                            target="_blank">Tuberculosis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <b>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=501&amp;Itemid=27" 
                            target="_blank">Pancytopenia</a></b></p>
                </td>
                <td class="second">
                    <p>
                        Multifactorial; likely cause(s) indicated by blood film findings and red cell 
                        indices. Bone marrow aspiration occasionally indicated, particularly if severe, 
                        unexplained anaemia, pancytopenia.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=51&amp;Itemid=27" 
                            target="_blank">Anaemia</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Alcohol marrow toxicity</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=83&amp;Itemid=27" 
                            target="_blank">Blood loss</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=379&amp;Itemid=27" 
                            target="_blank">Iron deficiency</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=236&amp;Itemid=27" 
                            target="_blank">Folate deficiency</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=345&amp;Itemid=27" 
                            target="_blank">Hypersplenism</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <b>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=82&amp;Itemid=27" 
                            target="_blank">Bleeding</a></b></p>
                </td>
                <td class="second">
                    <p>
                        <b>FBC, PT, APTT, thrombin time, fibrin degradation products, fibrinogen.</b></p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Failure of coagulation factor synthesis</p>
                </td>
                <td class="second">
                    See
                    <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=140&amp;Itemid=27" 
                        target="_blank">coagulation disorders</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=583&amp;Itemid=27" 
                            target="_blank">Vitamin K deficiency</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Hepatocellular failure</p>
                </td>
                <td class="second">
                    See
                    <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=304&amp;Itemid=27" 
                        target="_blank">hepatic failure</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=739&amp;Itemid=27" 
                            target="_blank">Thrombocytopenia</a></p>
                </td>
                <td class="second">
                    <p>
                        <b>Bone marrow aspiration</b> may be appropriate.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Alcohol marrow toxicity</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li><a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=345&amp;Itemid=27" 
                                target="_blank">Hypersplenism</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li><a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=186&amp;Itemid=27" 
                                target="_blank">DIC</a> (usually low grade)</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=231&amp;Itemid=27" 
                            target="_blank">Fibrinolysis</a></p>
                </td>
                <td class="second">
                    <p>
                        Primary fibrinolysis may occur and is usually low grade.</p>
                </td>
            </tr>
            <tr class="last">
                <td class="first">
                    <p>
                        Dysfibrinogenaemia&nbsp;</p>
                </td>
                <td class="second">
                    <p>
                        In severe liver disease, especially with hepatocellular carcinoma. <b>Thrombin 
                        time, reptilase time.</b></p>
                </td>
            </tr>
        </table>
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            <h2>
                Glossary Terms</h2>
            <div>
                <h4>
                    ALT :</h4>
                <p>
                    Alanine aminotransferase</p>
                <h4>
                    ALP :</h4>
                <p>
                    Alkaline phosphatase</p>
                <h4>
                    APTT :</h4>
                <p>
                    Activated partial thromboplastin time</p>
                <h4>
                    AST :</h4>
                <p>
                    Aspartate aminotransferase</p>
                <h4>
                    DIC:</h4>
                <p>
                    Disseminated intravascular coagulation</p>
                <h4>
                    FBC :</h4>
                <p>
                    Full blood count , full blood examination, complete blood count</p>
                <h4>
                    GGT :</h4>
                <p>
                    Gamma glutamyl transferase (transpeptidase)</p>
                <h4>
                    K :</h4>
                <p>
                    Potassium</p>
                <h4>
                    PT :</h4>
                <p>
                    Prothrombin time</p>
                <h4>
                    sp :</h4>
                <p>
                    Species</p>
            </div>
        </div>
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